The Role of Cardio-Ankle Vascular Index as a Predictor of Mortality in Patients on Maintenance Hemodialysis

Abstract

Aim Mortality rate of maintenance hemodialysis patients is known to be high. Cardio-ankle vascular index (CAVI) is an index reflecting the proper stiffness of the arterial tree from the origin of the aorta to the ankle. We aimed to clarify the utility of CAVI as a predictor of mortality in hemodialysis patients. The roles of age and nutritional conditions on survival were also examined. Methods We followed 242 patients undergoing hemodialysis for 6 consecutive years. Data from 209 patients (mean age was 60 ± 11 years) excluding those with ankle-brachial index <0.90 were then analyzed. CAVI and heart to ankle pulse wave velocity (haPWV) were measured using Vasera 1500. Results Thirty-eight hemodialysis patients who died during the 6-year period had higher age, cardiothoracic ratio (CTR), CAVI, and haPWV, and lower diastolic blood pressure, albumin, phosphate, and calcium phosphate product. The Kaplan–Meier curves for cumulative survival among the tertile groups showed that the mortality rate was higher in the highest tertile (T3) compared to T1/T2 for both CAVI and haPWV. Receiver operating characteristic (ROC) analysis revealed that CAVI had better discriminatory power for all-cause mortality compared to haPWV. In the Cox-proportional hazards analyses, 1 SD increase in both parameters contributed independently to all-cause mortality [CAVI: HR 1.595 (95% CI 1.108–2.297), haPWV: HR 1.695 (95% CI 1.185–2.425)], as well as age and CTR. Both parameters above the cut-offs estimated in the ROC analysis (CAVI ≥ 9.2, haPWV ≥ 8.9) also had independent contributions to mortality. Conclusion Through the 6 consecutive years of follow-up in 209 HD patients, increased CAVI might represent a major modifiable risk factor for all-cause mortality. Further research is needed to examine whether CAVI-lowering interventions contribute to improved prognosis.

Predictive ability of arterial stiffness parameters for renal function decline: a retrospective cohort study comparing cardio-ankle vascular index, pulse wave velocity and cardio-ankle vascular index0

“…Specifically, predictive performance of haPWV for renal function decline was lower compared with CAVI, despite many individuals with high haPWV showed relatively increased BP at the time of measurement. This result is consistent with our previous study showing that CAVI was more strongly associated than haPWV with mortality in hemodialysis patients [28]. The relatively weak predictive performance of haPWV for renal function decline compared with CAVI may be because of the underestimation of atherogenic risk factors other than elevated BP.…”

Association between cardio-ankle vascular index and cardiometabolic risk factors in HIV patients in Ghana

“…In this study, we found that CAVI increases in HIV patients treated with cART, but is similar among cART-naïve HIV patients and non-HIV controls. CAVI is a sensitive marker of arterial stiffness and several studies have shown that it predicts CVD in patients and the general population [ 9 , 10 ]. From our literature search, we found just two studies that reported CAVI in HIV patients.…”

“…This makes CAVI unique from other arterial stiffness that is based on pulse wave velocity (PWV), such as carotid-femoral PWV and brachial-ankle PWV [ 6 , 7 ]. CAVI has been reported in several studies to be associated with cardiovascular-related organ damage [ 8 , 9 ] and mortality [ 10 ]. Several studies conducted in Africa and other parts of the world have reported arterial stiffness in HIV patients using PWV [ 2 , 11–14 ].…”

Comparison of Predictive Ability of Arterial Stiffness Parameters Including Cardio-Ankle Vascular Index, Pulse Wave Velocity and Cardio-Ankle Vascular Index0

“…We have previously conducted a longitudinal study comparing CAVI with haPWV, an index incorporated into the CAVI structural equation including central and peripheral arteries. 19 Of the 209 hemodialysis patients, 38 died for 6 years. Resultantly, in the Cox-proportional hazards analyses, 1 SD increase in both parameters contributed almost equally to allcause mortality [CAVI: hazards ratio (HR) 1.595, haPWV: HR 1.695].…”